Microcirculatory hemodynamic indexes (HI) were assessed in patients with moderate and severe COVID-19. In both groups, a significant increase in the absolute spectral indexes (HI1, HI2, and HI3) and the ratio of low-frequency to high-frequency component (HI1/HI3) was revealed. In the group of severe infection, only the “slow” index (low-frequency HI1) of microcirculatory hemodynamics was significantly lower. The oscillatory indices MAYER1-3 and RESP1-3 were reduced in patients of both groups. The aggravation of the disease course was accompanied by depression of the low-frequency index HI1. Regulatory shifts compensate for disturbances in microcirculatory processes in moderate COVID-19, but severe course was associated with their decompensation.
Ассоциация генных полиморфизмов матриксных металлопротеиназ (-9,-12 и-20) и продуктов деградации коллагена I типа с постинфарктным ремоделированием левого желудочка
The physiological characteristics of skin blood flow can be described in terms of the hemodynamic indices (HI). The HI is derived from the laser speckle characteristics, which are governed by the cutaneous blood flow. A miniaturized dynamic light-scattering sensor was used to measure the speckle pattern from the finger root. Three groups of subjects from 15 to 25 years of age were tested. The first group included subjects who are actively engaged in sport activities; the second group included subjects with low level of physical activity; and the third group included healthy controls with moderate physical activity. The HI parameters were measured prior to and after the performance of a determined physical load. As a marker of cardiovascular fitness (CVF), we used the postload decay rate of HI. We found that the hemodynamic response to the physical load provides a statistically significant correlation with the postload heart rate decay. It was also found that postocclusion increase of the arterial HI is more prominent in the group with higher physical activity. These results indicate that hemodynamic indices can be used as an additional marker for cardiovascular fitness level.
Тяжелое течение COVID-19, сопровождаемое острой дыхательной недостаточностью, острым респираторным дистресс-синдром и полиорганной недостаточностью, наиболее часто наблюдается у пожилых (старше 65 лет), а также у сравнительно молодых пациентов с сопутствующими заболеваниями -сахарным диабетом, гипертонической болезнью, нарушениями сердечной, почечной или печеночной деятельности. При этом у больных возникает чрезмерная воспалительная реакция, которая сопровождается развитием «цитокинового шторма», разбалансированием и последующим истощением Т-клеточного иммунитета. Успешная терапия COVID-19 строится на восстановлении функций поврежденной иммунной системы, в том числе ликвидации «цитокинового шторма». С этой целью рекомендовано применение блокатора рецептора моноклонального антитела к IL6 (RIL6) тоцилизумаба (TCZ). Приведены сведения об успешном применении TCZ у больных тяжелой формой COVID-19, а также указаны его существенные недостатки -развитие неблагоприятных реакций -лимфоцитопении, тромбоцитопении, увеличения уровня IL6, аланин-и аспартатаминотрансферазы и др. Одновременно приведены обоснования для применения у таких больных иммуномодулятора тималина, способного ликвидировать «цитокиновый шторм», а также нормализовать состояние иммунной системы и предотвращать синдром диссеминированного внутрисосудистого свертывания. Приводятся типичные случаи лечения больных с тяжелыми формами COVID-19 при использовании на фоне стандартной терапии TCZ и тималина раздельно и совместно.
Aim. To reveal the role of a “youth protein” GDF11 in regulation of lipid metabolism and cardiovascular system work in essential hypertension (EH) in women taking antihypertension medications and regularly involved in moderate physical exercises (kinesitherapy).Material and methods. In all participants, the level of GDF11 was measured by immune enzyme assay, and levels of lipids; registration was done of blood pressure, echocardiography and circulation condition with a novel sensor of dynamic light scattering (mDLS).Results. In women with AH taking antihypertension medications, the level of GDF11 was lower more than 3 times. In EH patients the deviations found, in a shear flow velocity with significant increase of rapid velocity processes. Correlations found for GDF11 level with the age, blood pressure, condition of the heart work, hemodynamical and oscillatory indexes. In the EH group patients regularly doing exercises (kinesitherapy), the level of GDF11, blood pressure, lipid profile and all parameters of heart work and hemodynamics are close to normal.Conclusion. The “youth protein” CDF11 is a factor of prevention of AH. Kinesitherapy in EH patients normalizes GDF11, lipid profile, and significantly increases the work of cardiovascular system.
Aim. To study the influence of artificially created stress on hemodynamic parameters of peripheral microcirculation and variability of the heart rhythm in somatically healthy young individuals.
Materials and Methods. In the study 30 individuals were involved (of them 16 men) with the mean age 18.21.1 years. An artificial stress was created using Stroop method. Assessment of characteristics of hemodynamics of microcirculation (HM) was performed by the method of dynamic scattering of light from erythrocytes. The signal was integrated in the form of three hemodynamic indexes: HI (Hemodynamic Indexes). Low frequency index (HI1) was determined by a slow interlayer interaction, high frequency area (HI3) characterized fast shearing of layers. HI2 took intermediate position (precapillary and capillary blood flow). Variability of cardiointervals isolated from pulse component, was assessed by method of variation pulsometry (Heart Rate Variability, HRV).
Results. In the course of study, increase in the heart rate (HR) in the stage of testing was observed that confirms a high extent of stress load. In hemodynamics, redistribution of blood flow was noted toward slow shear velocities (near-wall blood flow). After cessation of stress load, hemodynamic parameters declined and returned to previous values. Parameters characterizing variability of rhythm LF (sympathetic component), HF (vagal activity), CVI (non-linear parasympathetic index) showed a tendency to growth; here, LF/HF ratio did not change.
Conclusion. In result of the carried out study it was possible to formulate a multifactor picture of variation of parameters of microcirculation and of autonomic regulation of cardiac rhythm specific of reactions of adaptation to induced stress. The quantitative criteria of the obtained shears may be integrated into stress indexes to be used in clinical practice. A portable mDLS sensor may be supplemented with specific assessment criteria and used for monitoring of adaptive reactions induced by stressful situations, and for taking early diagnostic and prognostic decisions in the clinical practice, and for self-control of a patient.
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